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Related Concept Videos

Heart Failure VII: Nursing Interventions01:30

Heart Failure VII: Nursing Interventions

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The first step in nursing management of a patient with heart failure involves thoroughly assessing the patient's medical history.Subjective Data: Obtain the patient's medical history of coronary artery disease, hypertension, myocardial infarction, and symptoms like dyspnea, orthopnea, and paroxysmal nocturnal dyspnea.Objective Data: Conduct a physical examination to identify findings such as jugular vein distention, pulmonary crackles, tachycardia, murmurs, peripheral edema, and vital signs,...
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Heart Failure V: Medical Management01:30

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Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
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Cardiomyopathy V: Interprofessional Care01:29

Cardiomyopathy V: Interprofessional Care

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Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
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Mitral Regurgitation IV: Nursing Management01:28

Mitral Regurgitation IV: Nursing Management

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Mitral regurgitation (MR) is a condition where the mitral valve does not close properly, leading to the backward flow of blood from the left ventricle into the left atrium during systole. This condition can arise from various causes, including rheumatic fever, infective endocarditis, or degenerative valve disease. Effective nursing management is crucial to optimizing patient outcomes and involves comprehensive assessment and targeted interventions.Comprehensive Patient AssessmentA detailed...
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Cardiomyopathy VI: Nursing Management01:29

Cardiomyopathy VI: Nursing Management

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Assessment: Nursing management of patients with cardiomyopathy begins with a thorough assessment of the patient's history, including a family history of cardiomyopathy or sudden cardiac death, personal history of heart disease, hypertension, diabetes, and any alcohol consumption or drug use.During the physical examination, assess vital signs, look for signs of heart failure (such as edema, jugular venous distention, and cyanosis), auscultate for abnormal heart sounds (like murmurs and gallops),...
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Heart Failure VI: Adjunct Therapies01:22

Heart Failure VI: Adjunct Therapies

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Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
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Author Spotlight: Workflow for Integrating POCUS Data into EHR for Managing Heart Failure Patients
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Do Self-Management Interventions Work in Patients With Heart Failure? An Individual Patient Data Meta-Analysis.

Nini H Jonkman1, Heleen Westland2, Rolf H H Groenwold2

  • 1From Department of Rehabilitation, Nursing Science and Sports (N.H.J., H.W., J.C.A.T., M.J.S.) and Julius Center for Health Sciences and Primary Care (R.H.H.G., A.W.H.), University Medical Center Utrecht, The Netherlands; Departments of Medical and Health Sciences and Department of Cardiothoracic Surgery (S.Å.), Department of Medical and Health Sciences, Division of Nursing Science (S.Å., A.S.), Department of Social and Welfare Studies (T.J.), and Department of Cardiology (A.S.), Linköping University, Sweden; Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain (F.A.); British Heart Foundation, Glasgow, UK (L.B.); Department of Cardiology, Deventer Hospital, The Netherlands (P.W.F.B.-A.d.l.P., D.J.A.L.); Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill (D.A.D.); Department of Health Services, University of Washington, Seattle (P.L.H.); Department of Internal Medicine, University of Michigan, Ann Arbor (M.H.); Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, The Netherlands (G.I.J.M.K.); Institute of Nursing Science, University of Basel, Switzerland (M.E.L.); Department of Nursing Science, Jönköping University, Sweden (J. Mårtensson); Instituto Universitario de Ciencias de la Salud, Universidad de A Coruña and INIBIC, A Coruña, Spain (J. Muñiz); Graduate School of Health Sciences, Hirosaki University, Aomori, Japan (H.O.); Department of General Practice and Health Services Research, University Hospital Heidelberg, Germany (F.P.-K.); Cardiovascular Division, Washington University School of Medicine, St. Louis, MO (M.W.R.); School of Nursing, University of Pennsylvania, Philadelphia (B.R.); Division of Cardiology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada (R.T.T.); and Department of Cardiology, University Medical Center Groningen, The Netherlands (D.J.v.V.). n.jonkman@umcutrecht.

Circulation
|February 14, 2016
PubMed
Summary

Self-management interventions benefit heart failure (HF) patients by reducing hospitalizations and improving quality of life. However, caution is advised for patients with moderate/severe depression, as interventions may increase mortality in this group.

Keywords:
heart failuremeta-analysisself care

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Area of Science:

  • Cardiology
  • Health Services Research
  • Patient Self-Management

Background:

  • Self-management interventions are common in heart failure (HF) care.
  • Existing trial results are inconsistent, and subgroup effectiveness is unclear.
  • This meta-analysis examines HF self-management intervention effectiveness and subgroup responses.

Purpose of the Study:

  • To assess the overall effectiveness of self-management interventions in patients with heart failure (HF).
  • To determine if specific patient subgroups respond differently to these interventions.
  • To analyze the impact on HF-related hospitalizations, all-cause mortality, and quality of life.

Main Methods:

  • Individual patient data meta-analysis of 20 randomized trials.
  • Included 5624 patients with heart failure (HF).
  • Utilized mixed-effects and Cox proportional-hazard models with interaction terms.

Main Results:

  • Self-management interventions reduced the risk of HF hospitalization or all-cause death (HR 0.80) and HF hospitalization (HR 0.80).
  • A small improvement in 12-month HF-related quality of life was observed (SMD 0.15).
  • A protective effect on HF hospital days was noted in patients <65 years; however, self-management reduced survival in patients with moderate/severe depression (interaction P=0.01).

Conclusions:

  • Self-management interventions are beneficial for HF patients regarding hospitalization and quality of life.
  • Findings do not support limiting interventions to specific subgroups.
  • Caution is recommended when applying self-management strategies to patients with moderate/severe depression due to increased mortality risk.